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OBGYN > UWISE OBGYN > Flashcards

UWISE OBGYN Flashcards

1
Q

What is the definitive tx for pelvic pain due to endometriosis?

A

-hysterectomy with bilateral salpingo-oophorectomy

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2
Q

What is a radical hysterctomy used to tx?

A

-cervical cancer

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3
Q

What is endometrial ablation a tx for?

A

-menorrhagia

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4
Q

What type of IUD can be used for tx of endometriosis?

A

-levonorgestrel IUD

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5
Q

When are hysterosonograms contraindicated?

A

-when an infection is present!

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6
Q

What are 7 things that are associated with ACE-inhibitor use during pregnancy?

A
  1. Oligohydramnios
  2. Fetal growth retardation
  3. Neonatal renal failure
  4. HypoTN
  5. Pulmonary hypoplasia
  6. Joint contractures
  7. Death
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7
Q

What is the most common abnormal karyotype encountered in spontaneous abortuses?

A

-Autosomal trisomies

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8
Q

What are late decelerations associated with?

A

-uretoplacental insufficiency

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9
Q

What is the most significant risk factor for developing postpartum depression?

A

-personal history of depression

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10
Q

What is a leukoplakia? What should be done when one is found?

A
  • leukoplakia = white plaque on the cervix

- should be biopsied ASAP, regardless of Pap smear outcome

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11
Q

How long does it take for the full response of leiomyomatas to GnRH agonists?

A

-three months

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12
Q

What 5 things does smoking increase the risk of in pregnancy?

A
  1. Placental abruption
  2. Placenta previa
  3. Fetal growth restriction
  4. Pre-eclampsia
  5. Infection
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13
Q

What amnt of proteinuria for mild pre-eclampsia? Severe ?

A
  • mild = >300mg

- severe = >5000mg

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14
Q

Next step for a complex ovarian mass in a postmenopausal woman?

A
  • surgical exploration
  • could be an old enometrioma that was never resolved, but ovarian cancer should be r/o
  • a complex cyst is not a physiologic cyst
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15
Q

What are the best imaging studies for anything involving the uterus and adnexa?

A
  • ultrasound!

- so MRI and CT scans are usually not useful!

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16
Q

When can a dating US be done if there is discrepancy in dating?

A
  • btwn 14-20 wks

- first trimester US are the most accurate in estimating dates

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17
Q

What test should be done first when fetal demise of one twin is noticed?

A
  • maternal fibrinogen level
  • when a dead fetus has been in utero for 3-4 wks the maternal fibrinogen level may decrease, which can lead to a coagulopathy
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18
Q

What is the spalding sign?

A
  • overlapping of fetal skull bones

- suggests fetal demise

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19
Q

What kind of growth restriction can be caused by uteroplacental insufficiency?

A
  • asymmetric GR

- normal length, weight is below normal, head is normal sized, small abdomen

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20
Q

What size fetal head will most likely need delivery via c-section?

A
  • > 12 cm
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21
Q

3 Risk factors for PMS?

A
  1. Family Hx of PMS
  2. Vit B deficiency
  3. Calcium deficiency
  4. Magnesium deficiency
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22
Q

How much blood loss is considered postpartum hemorrhage in a vaginal delivery? C-section?

A
  • vaginal delivery = >500 cc

- C-section = >1000 cc

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23
Q

When can pap smears be discontinued in elderly women?

A

-ages 65-70 yrs as long as they have had 3 consecutive negative pap smear or 2 negative within 10 yrs and no Hx of high grade cervical changes

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24
Q

4 Labor warnings?

A
  1. Contractions every 5 min for 1 hr
  2. rupture of membranes
  3. Fetal mvmnt less than 10 per 2 hrs
  4. Vaginal bleeding
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25
Q

Red-tender wedge-shaped area on the outer quadrant of the breast of a breast feeding woman?

A

-think: mastitis!

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26
Q

What 2 tocolytics are contraindicated in diabetics?

A
  1. Terbutaline

2. Ritodrine

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27
Q

What tocolytic is contraindicated in myasthenia gravis?

A

-magnesium sulfate

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28
Q

What are 4 common causes of acute pulmonary edema during pregnancy?

A
  1. Use of tocolytics
  2. Cardiac disease
  3. Fluid overload
  4. Preeclampsia
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29
Q

Why are pregnant women more suceptible to pulmonary edema?

A

-bc plasma osmolality is decreased during pregnancy

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30
Q

When is RhoGAM typically given?

A
  • at 28 wks gestation for any Rh-negative woman
  • again within 72 hrs of delivery to an Rh-negative woman if the baby was Rh-positive
  • for any pregnancy, even if it doesnt end in a viable fetus in an Rh-negative woman
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31
Q

Where is the most common site of spread for an endometrial cancer?

A

-lungs!

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32
Q

What is the most accurate for detecting Down Syndrome?

A

-Quadruple screen

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33
Q

How will a septic infant appear at birth when chorioamnionitis is present?

A
  • pale
  • lethargic
  • high temp
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34
Q

What happens respiratory wise in pregnancy?

A
  • pregnancy causes respiratory alkalosis
  • increased: inspiratoy capacity and reserve vol, + tidal volume, which causes an increase in minute ventilation
  • decreased: functional residual capacity, residual volume
  • overall causes physiologic shortness of breath
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35
Q

SV in pregnancy?

A
  • increases!

- both HR and SV increase!

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36
Q

Physiologic hydronephrosis in pregnancy?

A
  • due to compression of the ureter by the uterus and the right ovarian
  • dilation tends to be more on the right bc of the dextrorotation of the uterus
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37
Q

What is the most common site for metastasis of molar pregnancies?

A

-lungs!

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38
Q

Max recommended weight gain during pregnancy in patients who are: underweight? Normal? Overweight? Obese?

A
  • underweight : 28-40
  • normal: 25-35
  • overweight: 15-25
  • obese: 11-20
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39
Q

What is the best screening blood test to do for an AA couple (with no significant hx) for preconception counseling?

A

-Hb electrophoresis

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40
Q

What screening test offers the highest detection rate for aneuploidys?

A

-sequential screen = first trimester NT and PAPP-A + second trimester quad screen

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41
Q

Whats is the risk of fetal loss with CVS?

A

-1%

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42
Q

Recommended daily folic acid dose for normal pregnancy? High Risk?

A
  • normal = 0.4 mg/day

- high risk = 4 mg/day

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43
Q

Most common cause of variable deceleration?

A

-cord compression

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44
Q

Cause of late decelerations?

A

-uteroplacental insufficiency

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45
Q

What fetal complication can occur with the use of magnesium-sulfate in a preeclamptic patient?

A

-respiratory distress –> monitor the infant and give supplemental oxygen if necessary

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46
Q

How will an infant of chorioamnionitis look at birth?

A

-pale, lethargic, and have high temp

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47
Q

When should HIV testing be done on an infant born to a positive mom?

A

-begin at 24 hrs

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48
Q

What is the most common cause of postpartum hemorrhage?

A

-uterine atony

49
Q

What is the most common bacterial cause of endometritis?

A

-mix of aerobes and anaerobes from the genital tract

50
Q

Postpartum blues v depression?

A
  • blues = lasts less than 2 weeks, self limited

- depression = lasts longer than 2 weeks

51
Q

Btwn ages 30-65 what are the recommendations for cervical cancer screening?

A

-pap smear with HPV testing every 5 years

52
Q

What is classically the cause of intense nipple pain with breast feeding?

A

-candida

53
Q

4 Signs that a baby is getting sufficient breast milk?

A
  1. 3-4 stools in 24 hrs
  2. 6 wet diapers in 24 hrs
  3. Weight gain
  4. Sounds of swallowing
54
Q

Conditions that need to be met before methotrexate can be used for tx of an ectopic pregnancy?

A
  1. Pt must be hemodynamically stable
  2. Nonruptured ectopic pregnancy
  3. size of ectopic pregnancy < 4cm w/out fetal HR or <3.5 w/ fetal HR
  4. Normal liver enzymes
  5. Normal renal fctn
  6. Normal WBCs
  7. Patient is reliable for follow up
55
Q

What is the most common abnormal karyotype found in spontaneous abortuses in the first trimester?

A

-autosomal trisomies

56
Q

When should a cerclage be placed?

A

-after the first trimester when necessary

57
Q

When should patients at high risk be screened for GDM?

A

-ASAP with a 50-g oral gluocose challenge test

58
Q

What non-invasive test can be used to detect severe fetal anemia?

A

-middle cerebral artery peak systolic velocity

59
Q

Definition of fetal hydrops?

A

-collection of fluid in 2 or more body cavities of the fetus

60
Q

What test should be done to determine the correct RhoGAM dose to give when there is more than the routine 30cc of fetal blood mixing with maternal blood?

A
  • Kleihauer-Betke test

- causes maternal cells to be pale and fetal cells to remain stained, allows for counting of fetal blood cells

61
Q

What is the standard dose of RhoGAM? How many cc of fetal blood does it account for?

A
  • 300mg

- accounts for 30cc of fetal blood

62
Q

What is the best way to gauge the severity of Rh hemolytic disease?

A

-measurement of bilirubin in the amniotic fluid

63
Q

What type of twins most commonly has twin-twin transfusion?

A

-monochorionic diamniotic

64
Q

When is the risk of microcephaly and severe mental retardation the greatest during gestation?

A

-weeks 8-15

65
Q

What is considered a prolonged latent phase in a nulliparas woman? Multiparas?

A
  • nulliparas = >20 hrs

- multiparas = >14 hrs

66
Q

What 3 additional things does fresh frozen plasma contain?

A
  1. Fibrinogen
  2. Factor V
  3. Factor VIII
67
Q

What is the most common cause of preterm labor?

A

-idiopathic

68
Q

Which 2 tocolytics are CI in DM?

A
  1. Terbutaline

2. Ritodrine

69
Q

Which tocolytics is CI in myasthenia gravis?

A

-Magnesium sulfate

70
Q

MOA of Magnesium sulfate as a tocolytic?

A

-competes with calcium entry into the cells

71
Q

When should indomethicin not be used as a tocolytic? Why?

A
  • Should not be used after 32 wks

- can cause premature closure of the ductus arteriosis

72
Q

What 4 effects do fetal steroids have?

A
  1. Increase pulmonary maturity
  2. Decrease incidence and severity of RDS
  3. Decreases intracerebral hemorrhage
  4. Decreases necrotizing enterocolitis in newborns
73
Q

What medication has been shown to be the best in delaying the onset of labor in PPROM?

A

-antibiotics

74
Q

The presence of what in the amniotic fluid suggests an intra-amniotic infection?

A

-amniotic glucose level of <20 mg/dl

75
Q

What medication has been shown to reduce the risk of premature labor?

A

-17 alpha-hydroxyprogesterone

76
Q

What type of decelerations are associated with uteroplacental insufficiency?

A

-late

77
Q

What type of decelerations are associated with head compressions?

A

-early

78
Q

What type of decelerations are associated with cord compression?

A

-variable

79
Q

What should be done next for uterine atony that does not respond to medical tx?

A

-B-Lynch suture

80
Q

When does milk “let-down” usually occur?

A

-2-3 days post partum

81
Q

What effects can fluoxetine have on a fetus?

A

-pulmonary hypertension

82
Q

Postterm pregnancy?

A

-completed 42 weeks

83
Q

What are postterm pregnancies most commonly associated with?

A

-placental sulfatase deficiency

84
Q

What can amnioinfusions be a tx for?

A
  • tx of repetitive decelerations

- regardless of amniotic fluid meconium status

85
Q

What does a 4th degree laceration involve?

A

-extends into the rectal sphincter and mucosa

86
Q

Criteria for macrosomia in a diabetic mother? Non-diabetic?

A
  • diabetic = >4000 grams

- nondiabetic = >4500 g

87
Q

What cancer does a tubal ligation reduce the risk of?

A
  • ovarian

- mechanism unknown

88
Q

What is the strongest predictor of regret for a tubal ligation?

A

-age!

89
Q

Antiphospholipid antibody syndrome tx?

A

-aspirin + heparin

90
Q

Up to how many weeks can a vacuum assisted abortion be done?

A

-until 8 weeks

91
Q

Tx of BV?

A

Metronidazole

92
Q

Medical tx of detrusor instability?

A
  • anticholinergics

- ex oxybutynin

93
Q

Tx for endometriosis?

A

-OCPs + NSAIDs

94
Q

Kallmann syndrome: What is it? Tx?

A
  • arcuate nucleus doesnt secrete GnRH
  • olfactory tract hypoplasia
  • tx: pulsatile GnRH tx
95
Q

Puberty wise, what is seen in McCune Albright Syndrome?

A

-premature menses before breast and pubic hair dev

96
Q

Normal age of menarche?

A

-ages 9-17 yrs

97
Q

What hormone is abnormal in PCOS?

A

-elevated testosterone!

98
Q

Normal testosterone with a PCOS picture?

A
  • think late onset CAH

- get 17-hydroxyprogesterone level!

99
Q

Tx for hirsutism?

A

-spironolactone

100
Q

What is the classic histologic description of lessions of endometriosis?

A

-endometrial glands/stroma and hemosiderin-laden macrophages

101
Q

Histology of uterine fibroids?

A

-well-circumscribed, non-encapsulated myometrium

102
Q

How many mg of Ca do postmenopausal women require per day?

A

-1200 mg

103
Q

Most common reason why women stop taking postmenopausal hormone tx?

A

-vaginal bleeding

104
Q

Hormone tx affects on lipids?

A
  • increase HDL levels

- decrease LDL levels

105
Q

What is considered osteopenia?

A

-1 to -2.5

106
Q

What is seen on labs for exercise induced hypothalamic amenorrhea?

A
  • normal FSH

- low estrogen

107
Q

A deficiency in which vitamins has been shown to be related to an increase in PMS?

A

-vitamin A, E, & B6

108
Q

Tx of mild PMS?

A

-OCPs

109
Q

4 Risk factors for PMS?

A
  1. Family Hx
  2. Vit B6 def
  3. mag defi
    Calcium def
110
Q

What race has a higher risk for molar pregnancy?

A

-Asian

111
Q

Tx of molar pregnancies?

A

-suction curettage

112
Q

Partial mole?

A
  • contains fetus/fetal parts &/or placenta/placental cord
  • triploid karyotype (ex 69XXY)
  • from 2 sperm fertalizing 1 egg
  • show villi swelling
  • have longer “gestations”, lower beta-hCG levels, and tend to get diagnosed as missed or incomplete abortions
113
Q

Complete mole?

A
  • does not contain any fetal or placental parts
  • diploid (ex 46XX)
  • from fertilization of an “empty egg” by 1 sperm or by 2 sperm
  • show trophoblastic proliferation
  • usually present with larger uteri, preeclampsia
  • have higher likelyhood of developing into post-molar gestational trophoblastic neoplasia
114
Q

How long should a patient wait after a molar pregnancy to conceve again?

A

-wait for 6 mnths of negative beta-hCG levels

115
Q

Bx of suspicious choriocarcinoma lesions?

A

-NEVER!!! they are very vascular!`

116
Q

What is the most common vulvular cancer?

A

-squamous cell carcinoma

117
Q

Painless Mass in Bartholin’s gland?

A
  • suspicious for malignancy!

- bx it!

118
Q

abnormal pap in a 21-24 yr old?

A
  • do HPV testing
  • if positive, repeate pap in 1 yr
  • if negative, continue with paps every 3 yrs
119
Q

Tx for fibroids in a pt who wishes to remain fertile and hasn’t responded to NSAIDs?

A

-GnRH –> will shrink size only while on tx!

OBGYN (3 decks)

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